Healthcare Provider Details

I. General information

NPI: 1629286810
Provider Name (Legal Business Name): KATHRYN ANNETTE BRIZAL LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATHRYN ANNETTE MELENDEZ LPCC

II. Dates (important events)

Enumeration Date: 05/19/2007
Last Update Date: 11/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5608 ZUNNI RD. NE
ALBUQUERQUE NM
87108
US

IV. Provider business mailing address

3610 HAVASU FALLS ST NE
RIO RANCHO NM
87144-2549
US

V. Phone/Fax

Practice location:
  • Phone: 505-262-6068
  • Fax:
Mailing address:
  • Phone: 505-916-9091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC1591
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: